Endoscopic treatment or balloon-occluded retrograde transvenous obliteration is safe for patients with esophageal/gastric varices in Child-Pugh class C end-stage liver cirrhosis

다국어 초록 (Multilingual Abstract)

Background/Aims: There is a controversy about the availability of invasive treatment for esophageal/gastric varices in patients with Child-Pugh class C (CP-C) end-stage liver cirrhosis (LC). We have evaluated the validity of invasive treatment with CP-C end-stage LC patients.
Methods: The study enrolled 51 patients with CP-C end-stage LC who had undergone invasive treatment. The treatment modalities included endoscopic variceal ligation in 22 patients, endoscopic injection sclerotherapy in 17 patients, and balloon-occluded retrograde transvenous obliteration (BRTO) in 12 patients. We have investigated the overall survival (OS) rates and risk factors that contributed to death within one year after treatment.
Results: The OS rate in all patients at one, three, and five years was 72.6%, 30.2%, and 15.1%, respectively. The OS rate in patients who received endoscopic treatment and the BRTO group at one, three, and five years was 67.6%, 28.2% and 14.1% and 90.0%, 36.0% and 18.0%, respectively. The average of Child-Pugh scores (CPS) from before treatment to one month after variceal treatment significantly improved from 10.53 to 10.02 (P=0.003). Three significant factors that contributed to death within one year after treatment included the presence of bleeding varices, high CPS (≥11), and high serum total bilirubin levels (≥4.0 mg/dL).
Conclusions: The study demonstrated that patients with a CPS of up to 10 and less than 4.0 mg/dL of serum total bilirubin levels may not have a negative impact on prognosis after invasive treatment for esophageal/gastric varices despite their CP-C end-stage LC.

참고문헌 (Reference)

1 Clements W, "Variant treatment for gastric varices with polidocanol foam using balloon-occluded retrograde transvenous obliteration : a pilot study" 56 : 599-605, 2012

2 Numata K, "Use of balloon-occluded retrograde transvenous obliteration with ethanolamine oleate for the treatment of hepatic encephalopathy in a cirrhotic patient with a large spontaneous splenorenal shunt" 33 : 424-427, 1998

3 Kanagawa H, "Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration" 11 : 51-58, 1996

4 Blendis LM, "The role of hepatocyte enlargement in hepatic pressure in cirrhotic and noncirrhotic alcoholic liver disease" 2 : 539-546, 1982

5 Park SJ, "The prevalence, risk factors, and clinical outcome of balloon rupture in balloon-occluded retrograde transvenous obliteration of gastric varices" 21 : 503-507, 2010

6 Grossman HJ, "The effect of hepatocyte enlargement on the hemodynamic characteristics of the isolated perfused rat liver preparation" 27 : 446-451, 1998

7 Masaki M, "The destructive effects of sclerosant ethanolamine oleate on mammalian vessel endothelium" 25 : 230-235, 1990

8 Iwase H, "Symposium on endoscopic hemostasis in gastric diseases. 2. Choice of endoscopic therapy for esophagogastric varices: aiming for safer and more effective therapy" 36 : 128-129, 1997

9 Genda T, "Survival in patients with Child-Pugh class C cirrhosis : analysis of the liver transplant registry in Japan" 47 : 1155-1164, 2017

10 Arai H, "Respiratory effects of balloon occluded retrograde transvenous obliteration of gastric varices : a prospective controlled study" 26 : 1389-1394, 2011

11 Bhathal PS, "Reduction of the increased portal vascular resistance of the isolated perfused cirrhotic rat liver by vasodilators" 1 : 325-337, 1985

12 Uehara H, "Prediction of improved liver function after balloon-occluded retrograde transvenous obliteration : relation to hepatic vein pressure gradient" 27 : 137-141, 2012

13 Kawanaka H, "Portosystemic encephalopathy treated with balloonoccluded retrograde transvenous obliteration" 90 : 508-510, 1995

14 D’Amico G, "Natural history and prognostic indicators of survival in cirrhosis : a systematic review of 118 studies" 44 : 217-231, 2006

15 Garcia-Pagán JC, "Management of gastric varices" 12 : 919-928, 2014

16 Yoshida H, "Long-term results of partial splenic artery embolization as supplemental treatment for portal-systemic encephalopathy" 100 : 43-47, 2005

17 Fukuda T, "Long-term results of balloonoccluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy" 12 : 327-336, 2001

18 Chao Y, "Hepatic hemodynamic features in patients with esophageal or gastric varices" 19 : 85-89, 1993

19 Choi SY, "Foam sclerotherapy using polidocanol for balloon-occluded retrograde transvenous obliteration(BRTO)" 21 : 122-129, 2011

20 Choi YS, "Effect of balloon-occluded retrograde transvenous obliteration on the natural history of coexisting esophageal varices" 42 : 974-979, 2008

21 Orrego H, "Correlation of intrahepatic pressure with collagen in the Disse space and hepatomegaly in humans and in the rat" 80 : 546-556, 1981

22 장세영, "Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis: a retrospective multicenter study" 대한간학회 18 (18): 368-374, 2012

23 Tanihata H, "Changes in portal systemic pressure gradient after balloon-occluded retrograde transvenous obliteration of gastric varices and aggravation of esophageal varices" 32 : 1209-1216, 2009

24 Akahane T, "Changes in liver function parameters after occlusion of gastrorenal shunts with balloon-occluded retrograde transvenous obliteration" 92 : 1026-1030, 1997

25 Hasumi A, "Causative relationship between a hyperdynamic state due to increased A-V anastomoses in the gastric wall and AGML in patients with liver cirrhosis" 4 (4): 143-145, 1989

26 Miyamoto Y, "Balloonoccluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension" 18 : 934-942, 2003

27 Saad WE, "Balloon-occluded retrograde transvenous obliteration of gastric varices : concept, basic techniques, and outcomes" 29 : 118-128, 2012

28 Park JK, "Balloon-Occluded Retrograde Transvenous Obliteration(BRTO)for treatment of gastric varices : review and meta-analysis" 60 : 1543-1553, 2015